Ask an expert: Considering a midwife?

Midwives have facilitated childbirth for thousands of years and are a vital part of today's modern health care delivery system. Yet many women are surprised to learn that they can choose a certified nurse-midwife and still have their baby in a hospital – with or without epidurals and other modern comforts. We asked Linda Nelson, MSN, CNM, midwife and clinical supervisor at Providence Maternal Care Clinic, to address some of the questions and misconceptions she hears most often.

Q: Are midwife services available through Providence Health & Services?

A: Yes, Providence has offered midwifery since 1993, with excellent outcomes, including very high patient satisfaction and very low cesarean-section rates.

Q: How much training do midwives have?

A: While different types of midwives have different levels of training and certification, all Providence midwives are certified nurse-midwives. CNMs have the highest degree of education and training – they are registered nurses with master's or doctoral degrees in science or nursing.

Q: What are the main differences between partnering with a midwife versus an OB/GYN?

A: With the exception of surgical services, a certified nurse-midwife can provide the same care as an OB/GYN. Aside from that, the differences are more philosophical in nature (and here in Oregon, those differences are slight). While medical doctors, such as obstetricians, are generally trained in treating illness, midwives approach pregnancy as a condition of wellness. The care we provide reflects that perspective. Our philosophy is to empower women to be in charge of their own health and pregnancy, and to have confidence in their body's ability to manage this natural process. We spend a little more time teaching and talking – for example, providing information about diet, nutrition and emotional well-being – so women can leave their pregnancy a little healthier than when they started it. And midwives are very flexible and accommodating to whatever sort of birth experience a woman wants. Whether she wants to be in a hospital bed with all of the comforts of modern technology, or to set technology aside and take a more natural approach, we'll help her have the experience she wants.

Q: If I choose a midwife, can I still have an epidural?

A: Yes, as with any delivery, patients under the care of a midwife may receive an epidural if they so choose. The Providence CNMs all deliver babies in our hospitals, where epidurals are available.

Q: What if something happens and I need a cesarean section?

A: Certified nurse-midwives are trained to recognize when things aren't progressing normally, and to know when to call in an OB/GYN for backup. At Providence, we maintain a close, long-term, collaborative relationship with an outstanding group of OB/GYNs whom we respect and trust. If you require a cesarean section, one of these OB/GYNs will perform the surgery. In addition, if you develop certain risk factors during the course of your pregnancy, our on-staff physician medical director will personally oversee your care. The women who come to us feel safe and secure, knowing that they have this level of backup and support.

Q: Can I choose a midwife for all of my gynecological care?

A: Yes. Providence's certified nurse-midwives provide well-woman gynecological checkups, Pap smears, pelvic exams and related services, just like a gynecologist. In the event that you require gynecological surgery, we call on our trusted OB/GYN collaborators to provide that care for you.

Q: What's it like to go through pregnancy and childbirth with a certified nurse-midwife?

A: During your first appointment – whether you are pregnant or planning a pregnancy – your certified nurse-midwife will spend about an hour with you. She will take a detailed history of your health, do a physical exam to assess your current health, and talk with you about how to maximize your health from here on out for a healthy pregnancy. If you're not sure of your due date, she'll perform or schedule an ultrasound to determine that. She'll go over all of the resources and options that are available to you, and will take time to answer all of your questions.

During the first several months of your pregnancy, your CNM will see you monthly, with more frequent visits as your delivery date approaches. She will monitor the development of the fetus by measuring your abdomen and listening to the fetal heartbeat. And she'll keep a close watch over your health, as well, making sure that your blood pressure is within normal limits and that no other health concerns have arisen. At each appointment, you'll have ample opportunity to ask more questions.

As your delivery date nears, your midwife will have a long, involved visit with you and your support network to talk about your birth plan. When you go into labor, your CNM will go to the hospital with you, and will stay with you and support you through the entire labor and delivery process. She may offer back rubs to relieve pain, interpret fetal monitors to track the baby's progress, suggest that you get up and move around or try different positions to improve your comfort, or offer support in myriad other ways. When the big moment finally comes, your midwife will deliver your baby. Afterwards, she can assist you with breastfeeding questions, and will see you for your postpartum checkups, as well – usually at two weeks and six weeks after delivery.

In 22 years as a certified nurse-midwife, I have delivered more than 2,000 babies for women in the Portland area. Just about every trip to the grocery store means running into someone I have delivered, and it's one of the most fun parts of my life, getting to see so many happy, satisfied "customers" in my community.